Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2012;85(5):456-457

See related article on labor analgesia.

How painful will my labor be?

There is no way to know what your labor will be like. Pain during childbirth is different for every woman and depends on several things. Some women need little or no pain relief. Others find that pain medicine gives them better control over their labor and delivery.

What are my choices for pain relief?

There are several choices for managing pain. Trained personal labor assistants (also called doulas) have been shown to help with pain during labor by offering encouragement and support. Soaking your body in water (at body temperature) during the first part of labor also may help with pain.

Other options, such as medicine through a catheter (a thin plastic tube), can be given by a nurse. Pain medicines that go into your back are given by specially trained doctors or nurses. These medicines include epidurals and spinals.

Other ways to manage pain during labor include birth balls, squatting bars, showers, rocking chairs, heated blankets, and massage tools.

When do I need to decide what kind of pain relief I want?

Knowing your choices ahead of time may help your delivery go more smoothly. Keep your options open in the weeks before labor. Some women plan to have certain treatment, but then decide they do not need it. Other women may plan not to have any treatment, but then change their mind.

Talk to your doctor about your options. You should not feel pressured to take or refuse pain relief during labor.

What is a pudendal block?

A pudendal block is a shot of medicine given into the vagina before delivery. The pudendal nerve is what makes you feel pain during labor. This shot will make the vaginal area numb. It works quickly and gives almost complete pain relief from vaginal pain, but it will not stop the pain from contractions.

What are opiates?

Opiates are a type of pain medicine usually given through a catheter. They are given only in small doses and only during the early stages of labor to avoid possible side effects for the mother and baby.

What is the difference between a spinal and an epidural?

Both are used to relieve pain or numb a specific part of the body, and both involve placing a needle in the lower part of the back. A spinal is a single shot of medicine with a needle that is removed right away. An epidural is a catheter that is put through the needle into the epidural space, which is near the spinal column. The needle is then removed, leaving the catheter.

A spinal is usually used for short procedures when the doctor knows how long it will take, such as a planned cesarean delivery. The medicine makes you numb for a certain length of time, and then it wears off. An epidural is used when the doctor does not know how long pain relief is needed, such as during labor. Some labors are quick and some last several hours. With an epidural, medicine is given continuously, and the pain relief can last as long as needed.

How long do they take to work?

Pain relief begins after one to 15 minutes. Spinals usually work faster than epidurals. Because of this, they are often used together. Only one needle stick is needed to get both an epidural and a spinal.

Do they hurt?

The area where the epidural or spinal is given will be numbed, so there is only a little pain. Most women will feel some pressure. It can be uncomfortable, but most women find that the pain relief it gives during delivery is worth it.

Will I feel contractions, and will I be able to push?

If you get a spinal or epidural, you should still be aware of the contractions and be able to push. There is a small increase in the risk of not feeling contractions. If this happens, you may need help to deliver vaginally with the aid of a vacuum or forceps device.

Can I walk or go to the bathroom with an epidural or spinal in place?

Maybe. It depends on the type of epidural you get, how your body responds to the medicine, and the policies of the place where you are delivering. Ask your doctor about what to expect during your delivery.

Are there side effects?

About 1 percent of patients get headaches after a spinal or epidural. The headache may last a few days, but it can be treated. Allergic reactions from spinals or epidurals are rare, but itching is more common. A brief period of numbness after the epidural is removed also is common.

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